DEAR DR. ROACH: I have normal pressure hydrocephalus (NPH) and had a spinal tap a few months ago. It helped my brain fog, but my neurosurgeon didn’t want to put in a shunt. I am 96. Can repeated taps help me? — M.G.

ANSWER: NPH is a condition where the fluid inside the brain has a high pressure. It is unknown why this happens, but symptoms include an abnormal gait and incontinence along with the brain fog you mentioned.

When NPH is suspected, a spinal tap is a useful diagnostic test. Taking a lot of spinal fluid out, which suspends the brain and spinal cord, will temporarily lower the pressure, and if a person’s symptoms (especially their walk) get immediately better, this is a strong sign that the diagnosis is NPH.

Unfortunately the pressure builds back up within a few days, so the cure might be even worse than the disease if you needed a spinal tap every few days. There are no medications that have been proven to be effective.

This leads me to wonder why your neurosurgeon didn’t want to do the shunt, which is the definitive treatment for NPH. A shunt drains spinal fluid into the abdomen, allowing the pressure to stay low. It’s the one treatment that improves a person’s function.

While I understand that operating on the brain at age 96 has the possibility for complications, NPH tends to worsen over time. Perhaps a second opinion would be wise.

DEAR DR. ROACH: I read a recent column where you addressed the perils of microplastic polymer particles. Please elaborate on which bodily illnesses/problems arise as a result of this problem and how it manifests itself within our body. — C.C.

ANSWER: There aren’t good studies that have yet determined the risk from microplastics. While they have been suspected of causing harm in multiple organ systems, the magnitude of the harm isn’t well-understood in humans. In particular, the digestive system may be affected through chronic inflammation and changes in the microbiome. The lungs may have reduced gas exchange. There may be changes in male reproductive health, and there is concern but not proof of an increased cancer risk.

I find it frustrating that there is information about the potential harms of microplastics but not enough good evidence to estimate what the risk might be. However, until these risks are better known, there are a few steps to help reduce exposure:

° Change plastic water bottles for glass or steel. Tap water has less microplastics than bottled water

° Don’t microwave foods in plastic

° Use glass or ceramic containers for storage

° Avoid highly processed foods

° Vacuum your living space with a high-efficiency particulate air (HEPA) filter

° Use home-filtration devices that have very small filters (about 0.2 micrometers)

Most of this advice is good for either you or the environment (or both), so taking this advice won’t be a waste. Most of the work that needs to be done to reduce microplastics in the environment needs to happen at a systems level. For example, among the largest root causes of microplastics is oceanic plastic debris. Solving this is beyond my capacity.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved